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HomeMy WebLinkAbout6312 - COI - Henden Electric Inc - 2025®Allstate. You're In good Mnds. CERTIFICATE OF INSURANCE CI CW A021011 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any parry nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder: Named Insured: CITY OF BREMERTON HENDEN ELECTRIC, INC . RECEI Y `� 345 6TH ST STE 600 26124 CALVARY LN NE v BREMERTON, WA USA 983371873 KINGSTON WA 98346-9441 DEC T 2 2023 City of BremertoF� Automobile Liabilit Insurer Name: Allstate Insurance Com an Polic Number: 648744039 1 --Any Auto 2 -Owned Autos Only 3 -Owned Priv. Pass. Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Onl 5 -Owned No Autos Subject to Fault 6 -Owned Autos Subject to a Compulsory UM Law X 7 -- S ecificall Described Autos X 8 -Hired Autos Onl X 9 - Nonowned Autos Onl Policy Effective Date : O 1-18 - 2 0 2 4 Policy Expiration Date: 01-18 - 2 0 2 5 Limits of $1, 000, 000 Combined Single Limit (each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of O rations/Locations/Vehicles/Endorsements/S aal Provisions Interested Pa T Additional Insured - All Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT POLICY LANGUAGE OR ENDORSEMENT. POLICY(IES) MUST WITH ADDITIONAL INDICATED IN SUCH Producer: CHISHOLM INSURANCE Authorized Representative: Date:ll-22-23 Includes copyrighted material of Insurance Services Office, Inc., with its permission �tutl,t � CI CW A021011 Allstate Insurance Company Additional Insured Copy Page 1 of 1 ®Allstate. Yo�ire In good hands. COMMERCIAL AUTO AA CW 23 0914 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT Coverage provided under this policy is modified by the attachment of this endorsement If there is any conflict in coverage provisions between this form and any state specific endorsement also attached to this policy, the provisions) of the state specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Endorsement Effective: 01-18 - 2 0 2 4 Named Insured: HENDEN ELECTRIC, INC. SCHEDULE Name of Persons) or Organization(s): CITY OF BREMERTON 345 6TH ST STE 600 BREMERTON, WA USA 983371873 If no entry appears above, information required to comp as applicable to the endorsement. Countersigned By: orized orsement will be shown in SECTION IV —BUSINESS AUTO CONDITIONS,B.General Conditions, 5. Other Insurance is modified by this endorsement, only as it applies to any coverage provided to the person or organization designated in the schedule of this endorsement and only to the extent that such person or organization qualifies as an "insured" under this policy. If the named insured has entered into an agreement with the person or organization designated in the Schedule of this endorsement, which requires that the insurance available to them under this policy be applied on a primary and non-contributory basis, the following provision applies: Any coverage provided under this policy to the person or organization designated in the Schedule of this endorsement is primary, and we will not seek contribution from any other Automobile Liability insurance otherwise available to the designated person or organization. �'r •: '•� Includes copyrighted material of Insurance Services Office, Inc., with its permission �un��-.; AA CW 23 0914 Allstate Insurance Company Pddilional Insured Copy Page 1 of 1 ®Allstate. You're In good hands. POLICY NUMBER: 648744039 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies persons) or organizations) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Namedlnsured: HENDEN ELECTRIC, INC. Endorsement Effective Date: 01-18 - 2 024 SCHEDULE Name Of Persons) Or Organization(s): CITY OF BREMERTON 345 6TH ST STE 600 BREMERTON, WA USA 983371873 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. ��!�i�1 3 CA 20 481013 ©Insurance Services Office, Inc., 2011 Pddilional Insured Copy Page 1 of 1 ®Allstate. You're in good hands. a BU114-3 CUSTOMER NUMBER: 1156002 CHISHOLM INSURANCE 19045 HWY 305 #204 POULSBO, WA 98370 CITY OF BREMERTON 345 6TH ST STE 600 BREMERTON, WA 98337-1873 RUN DATE: 08-08-2024 33WO $,Aewo4V A _--I uWreu,ejg 10 N!O a3/113�32i 10000240808648744039101500011 X001 002 ADDITIONAL INSURED • OTHER ®Allstate. You're in good hands. Named Insured & Mailing Address: HENDEN ELECTRIC, INC. 26124 CALVARY LN NE KINGSTON WA 98346-9441 ALLSTATE INSURANCE COMPANY 2775 SANDERS ROAD BUILDING D2W NORTHBROOK IL 60062 REINSTATEMENT NOTICE Producer: 98911 CHISHOLM INSURANCE 19045 HWY 305 #204 POULSBO WA 98370 RECEIVED AUG 14 7.024 City of Bremerton City Attorneys Office Policy No.: 648744039 Type of Policy: AUTO LIABILITY AND PHYSICAL DAMAGE You recently received a notice advising this policy was being cancelled effective 08/10/2024 . This notice is to advise that the policy is being reinstated without lapse in coverage. Additional Insured CITY OF BREMERTON R ;r 345 6TH ST STE 600 BREMERTON WA 98337-1873 Date Mailed: 8th day of August, 2024 AUTHORIZED REPRESENTATIVE BU 114 -3 FORM# CT969897WA51995 ODEN 3.0.24.06a Copy for Additional Insured WACT1 08082024MNNY Page 1 of 1 ALLSTATE INSURANCE COMPANY (PA11state. 2775 SANDERS ROAD You're in good hands. BUILDING D2W NORTHBROOK IL 60062 NOTICE OF CANCELLATION OF INSURANCE Named Insured & Mailing Address: HENDEN ELECTRIC, INC. 26124 CALVARY LN NE KINGSTON WA 98346-9441 Producer: 98911 CHISHOLM INSURANCE 19045 HWY 305 #204 POULSBO WA 98370 RECEIVED JUL 31 2024 City of Bremerton Risk Management Policy No.: 648744039 Type of Policy: AUTO LIABILITY AND PHYSICAL DAMAGE Date of Cancellation: 08/10/2024; 12:01 A.M. Local Time at the mailing address of the Named Insured. We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above. The reason for cancellation is NON-PAYMENT OF PREMIUM. Your interest in this policy as an "insured" or other party of interest is being cancelled effective 08/10/2024; 12:01 A.M. Local Time at the mailing address of the named insured. Additional Insured CITY OF BREMERTON 345 6TH ST STE 600 BREMERTON WA 98337-1873 Date Mailed: 23rd day of July, 2024 AUTHORIZED REPRESENTATIVE WACC1NONPMNT [32069 FORM# CC9697WA51995 07232024MY ODEN 3.0.24.06a Copy for Additional Insured Page 1 off I